International Medical Publisher Journals (iMedPub)
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Antibiotic resistance rates among bacterial isolates from infected patients of intensive care unit over the period (2011-2016) in Bursa, Turkey: The Comparison Of The Antibiotic Resistance Rates
Get PDFBackground: The aims of this study were to evaluate the microbiological datas for effective infection control and specific antimicrobial stewardship and to report the epidemiology of ICU-acquired infections and the local antimicrobial resistance of pathogen microorganisms.
Methods: Datas were collected between January 2011-October 2016 retrospectively from the cardiology and cardiovascular surgery patients. The identification and antimicrobial susceptibility analyses in clinical isolates of pathogen microorganisms were determined by the automatic device system.
Results: Klebsiella pneumoniae was detected increasingly resistant to imipenem (IMP) significantly (p=0.048). Acinetobacter baumanii was found increasingly resistant to amikacin (AN), gentamicin (GN), trimethoprim-sulfamethoxazole (SXT) and tetracycline (TE) significantly (p=0.045, p=0.030, p=0.006, p=0.027). There was a significantly decrease in the resistant rates of IMP, piperacillin-tazobactam (TPZ), meropenem (MEM) and ciprofloxacin (CIP) for Pseudomonas spp. (p=0.048). In all of the gram-negative microorganisms, significantly increasing resistance rates to cefepime (CEP) was detected (p=0.015). In all of the gram-positive microorganisms, significantly decreasing resistance rates to teicoplanin (TEC) was also detected (p=0.034).
Conclusion: As a result, the inadequacy of infection control measures such as hand hygiene and patient isolation to prevent transmission between patients has increased the carbapenem-resistant Klebsiella pnemoniae (CR-KP) ratio, which is frequently found in recent years in our hospital. However, preferring preemptive treatment as a result of cooperation with microbiology laboratory instead of empirical treatment with antibiotics such as carbapenem and vancomycin caused the decrease in the resistance rates of resistant microorganism
Assessment of renal safety of tenofovir disoproxil fumarate in people living with HIV in Tunisia
Get PDFBackground: Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor (NRTI). TDF is generally well tolerated. It is eliminated by the combination of glomerular filtration and active renal tubular secretion. Thus, it can be responsible, in the medium and long term, of renal toxicity. The aim of our study is to assess the prevalence of TDF nephrotoxicity and its factors risk in PLHIV treated in the Infectious Diseases Department at the University Hospital of Monastir, Tunisia..
Methods: An observational cross-sectional single-centre prospective study included 62 cases of HIV-infected patients taking antiretroviral therapy (ART) containing TDF was conducted between 1st August 2016 and 31 December 2016 at Fattouma Bourguiba University Hospital of Monastir, in Tunisia. During this period, patients were screened for renal dysfunction to detect renal toxicity, Tubular dysfunction or Fanconi syndrome.
Results: 62 patients were included with female/male ratio at 1,52. The mean age was 39 years ± 8,5 years. Half of the patients were treated with TDF as first-line therapy. The average duration of TDF was 25 months, the duration was greater than 12 months in 40 (65%) patients. There was a decrease in creatinine clearance in 21 (33.8%) patients, the average of the decrease was 128,6 ±35,8 ml/min Proximal tubulopathy was noted in 1 patient (1.6%) and no patient had Fanconi syndrome.
No risk factors for renal impairment under TDF were found. This finding could be explained by the small sample size
Conclusion: TDF-related renal toxicity is often asymptomatic, it require early detection. In ours patient cases, TD is rare, but creatinine clearance decrease is frequent and may inform of possible TD in these patient. In order to reduce TDFtoxicity, a new pro-drug, tenofovir alafenamide (TAF), is now available
Prevalence and antibiotic susceptibility of ear pathogens isolated from patients in Tripoli, north of Lebanon
Get PDFBackground. Urinary tract infection (UTI) is a severe public health problem. However, infected patients are usually treated empirically without preceding culture or antibiotics susceptibility testing, which may increase the antibiotic resistance level. The aim of this study is to determine the prevalence and antibiotic susceptibility patterns of common bacterial uropathogens isolated in Akkar governorate, North Lebanon.
Methods. Spot midstream from urine samples from 9662 patients presenting UTI symptoms who came to Youssef Hospital Center located in Akkar governorate, were collected in sterile plastic cups. Culture, identification and antibiotic susceptibility testing were performed through conventional tools according to the manufacturer’s recommended procedures and the recommendations of the European Committee on Antimicrobial Susceptibility Testing.
Results. Overall, a total of 1009 bacterial uropathogens were isolated. Escherichia coli was predominant and represented 72.5% of all isolates , followed by Klebsiella pneumoniae (8.2%), Enterococcus spp. (5.5%), Pseudomonas aeruginosa (4.5%), Proteus spp. (3%), Enterobacter spp. (2%), Staphylococcus aureus (2%), Streptococcus agalactiae (1.6%), Staphylococcus saprophyticus (0.4%), Acinetobacter baumannii (0.2%) and Providencia rettgeri (0.1%). Moreover, the mean antibiotic resistance rates of isolates was relatively high, but similar to previous investigations reported in our country.
Conclusion. To our knowledge, this is the first investigation reporting epidemiological data regarding the prevalence and antibiotic susceptibility patterns of uropathogens isolated from patients in Akkar governorate. Our data indicated the urgent need of a strategic plan to tackle antibiotic resistance, particularly in deprived regions with poor healthcare structures such as Akkar governorate.
DOI: http://dx.doi.org/10.3823/80
Resistance profiles and biofilm formation of coagulase negative staphylococci isolated from clinical specimens in a tertiary care hospital in Palestine: Resistance profiles and biofilm formation of CoNS from Palestine
Get PDFBackground: Coagulase-negative staphylococci (CoNS) represent one of the major resistant nosocomial pathogens where its biofilm-related infections often fail to respond to antibiotic chemotherapy. Here, we studied the resistance profiles and biofilm formation in CoNS isolates from clinical specimens at Al Shifa hospital in Gaza, Palestine.
Methods: This study was carried out from March to July 2016 and included 81 clinical isolates. Identification and antibiotic susceptibility testing were performed using VITEK-2 system. The presence of nuc and mecA genes was performed using multiplex PCR. Qualitative and quantitative biofilm assays were performed using standard methods.
Results: Of the 81 clinical CoNS isolates, S. haemolyticus was the most common species (34, 42%), followed by S. epidermidis (26, 32.1%) and S. saprophyticus (13, 16%). The majority of isolates (83.9%) were from surgery, ICUs, pediatrics and medicine wards and the most common source was pus (28, 34.6%). Antibiotic resistance was highest against aminoglycosides, β-lactams, carbapenems, cephalosporins, fluoroquinolones, fosfomycin and macrolides. Though, no resistance was detected against rifampicin, vancomycin, teicoplanin, nitrofurantoin, linezolid and mupirocin. The antibiotic resistance among MR-CoNS was significantly higher than that among MS-CoNS. Nearly 88.9% of isolates were multidrug resistant with higher percentage among MR-CoNS. Most S. epidermidis (76.9%) isolates were biofilm producer, with statistically significant association between methicillin resistance and biofilm production.
Conclusions: High rates of antibiotic resistance were found among CoNS to commonly used antibiotics and the majority were methicillin and multidrug resistance. Most S. epidermidis isolates were biofilm producer. These results justified the necessity for national programs and measures to monitor and manage the usage of antibiotics in the Palestinian hospitals and community
Antimicrobial effect of phytic acid on Enterococcus faecalis
Get PDFObjective One of the properties of an ideal root canal irrigant is the ability to eradicate Enterococcus faecalis which is one of the most resistant microorganisms encountered in persistent peri-radicular lesions. The aim of this study was to test the in vitro antibacterial effectiveness of a naturally occurring agent called phytic acid (IP6) against E. faecalis and compare it to the antibacterial activities of clinically used irrigants: sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), phosphoric acid (PA) and chlorhexidine (CHX).
Design The antimicrobial activities of 5% IP6, 5% NaOCl, 18% EDTA, 37% PA and 2% CHX against E. faecalis were determined using disk diffusion test. Minimum inhibitory concentration (MIC) was calculated by broth macrodilution method. The minimal bactericidal concentration (MBC) was determined for the used agents by culturing the clear broth of MIC tests.
Results The results of agar diffusion test showed statistically signiï¬cant differences between the groups. PA showed a larger zone when compared to other tested materials (p< 0.05). There was no statistical significant difference between NaOCl, EDTA and CHX (p=0.098). IP6 showed the smallest zone of inhibition when compared to all groups (p< 0.05).The recorded MIC and MBC values for IP6 were 0.156% and 0.625%; respectively. The MIC and MBC values for PA were 0.578% and 4.6% and for NaOCl 0.093% and 0.375%, respectively. EDTA MIC value was 0.14 % but it showed no bactericidal activity. CHX was excluded from MIC test as immediate precipitation and turbidity occurred after mixing CHX with Mueller Hinton Broth.
Conclusions Within the limitation of this study and despite that IP6 showed the smallest zone of inhibition in agar diffusion test, the results of MIC and MBC indicated that IP6 exhibits in vitro antibacterial effect against E. faecalis at low concentrations
Increased colistin resistance of Acinetobacter species in intensive care unit-acquired infections in a tertiary care hospital: Increased colistin resistance
Get PDFBackground: The aim of our study was to evaluate the antimicrobial resistance rates among pathogen microorganisms especially colistin resistant rates of Acinetobacter baumannii in intensive care unit (ICU)-acquired infections and to determine infection-specific correct treatment strategies.
Methods: The data of adult and newborn infant patients diagnosed with ICU-acquired infection in a tertiary education and research hospital in Bursa in 2014 and 2016 were analyzed, retrospectively.
Results: Acinetobacter baumannii was the most frequent pathogen of ICU-acquired infections in 2014 and 2016. There was a significant increase in colistin (CO) resistance rates in A. baumanii (0.0%-6.8%). A significant increase in CO, cefepime (FEP), ciprofloxacin (CIP) resistance rates was established in all gram negative bacteria (0.0%-7.9%, 50.0%-91.9%, 54.7%-74.6%), respectively. A significant increase in the rate of detection of A. baumanii as the pathogen microorganism in respiratory tract infection (RTI) was established (53.9% -79.5%). In addition, the average ventilator-associated pneumonia (VIP) infection rate also increased in 2016 compared to 2014 (VIP rate 2014: 7.12, 2016: 7.45, per 1000 ventilator days). A significant decrease in the rate of detection of all gram negative microorganisms in the surgical site infection (SSI), and a significant increase in the rate of detection of all gram positive microorganisms in the SSI was determined.
Conclusion: Increased antimicrobial resistance, especially increased colistin resistance rates in ICU-acquired infections, necessitates the creation of new strategies in empirical therapy. Detection of antimicrobial resistance profiles of local and infectious pathogen microorganisms in ICUs is a good guide for correct antimicrobial management
Candida Endophthalmiltis Following Penetrating Keratoplasty in Patient with Negative Donor Rim; A case report with review literature of diagnosis and treatment of fungal endophthalmitis.
No full text This is a case of young patient presented with granulomatous anterior and posterior uveitis, which turned to be fungal endophthalmitis after penetrating keratoplasty. Her symptoms were undetected because she was on systemic and topical steroids.
Key words: Candida, Endophthalmiltis, Penetrating Keratoplasty, negative donner rim.
The patient is 25 years old Caucasian female patient, previously medically free, who visited our department in the city of Amman, Jordan, for left penetrating keratoplasty for severe keratoconus. After an initial improvement in her vision and a smooth postoperative course, she presented with drop of vision, photophobia, and non-specific eye pain, on examination was found to have anterior granulomatous uveitis. She was started on systemic steroids and the topical steroids were increased in intensity. The initial systemic workup for granulomatous anterior uveitis was negative. However, culture from the aqueous was positive for Candida Galibrata, but the donor rim was negative. Later on the patient developed vitritis despite being on systemic fluconazole and topical Amphotericin B. She was treated with intravitreal Amphotericin B.
The vitritis improved, but vitreous opacities developed which deteriorated her vision. A parsplana vitetrectony was done.
Her final visual acuity remained poor because of opacified graft.
The patient’s unfortunate case represents a Candida endophthalmitis after penetrating keratoplasty despite being medically free
Pharmacokinetics / pharmacodynamics consideration in treating critically septic patients and correlates of bacterial killing: a review article
Get PDFCritically septic patients carry high mortality; however, it may be ameliorated to some extent by the appropriate prescription of antimicrobials and appropriate dosing strategy. Drug metabolism in critically septic patients differ from other less critical patients, and antimicrobial treatment need to be adjusted to prevent under dosing. The augmented clearance, acute kidney injury, microvascular ischemia, all affect antimicrobials’ levels. Methods of antimicrobial administration were explored, continuous infusion versus intermittent bolus, with the aim of maximizing drug exposure, hitherto, apart from PK/PD advantage, it was not translated clearly into patients’ clinical outcome. Biofilms have a unique management as they need elevated antimicrobial dosages to assure adequate drug exposure, and agents that work directly on biofilms to assure its disruption. Application of PK/PD knowledge in the management of critically septic patients maximize the clinical outcome and assures proper drug exposure, avoiding under dosing and drug toxicity, and decreasing the chance of antimicrobials mutant’s selection, and therapy failures
 
Management of Psuedomonas Keratitis: a review article
Get PDFBacterial keratitis can lead to severe vision loss and corneal scarring, and possibly perforation. Early and appropriate management is a key factor in decreasing and preventing complication.
Pubmed and Medline were searched for articles related to Pseudomonas keratitis between year 2000 and 2017 to get current guidelines about the management of Pseudomonas keratitis. These articles are reviewed in this review article and information related to management is summarized.
The most used agents to treat Pseudomonas are either aminoglycosides (usually gentamicin) fortified with a cephalosporin or mono therapy with a fluoroquinolones usually ciprofloxacin. In most areas, most strains of Pseudomonasare sensitive to ciprofloxacin. The role of topical steroids is discussed, as well as, available options for treatment of multi drug resistant Pseudomonas
Bioactivity of pyocyanin of Pseudomonas aeruginosa clinical isolates against a variety of human pathogenic bacteria and fungi species
Get PDFPyocyanin is blue pigment redox active, secondary metabolites produced by P. aeruginosa. The present study investigated the bioactivity of pyocyanin against certain types of bacteria and fungi causing human infections
Objectives: Pyocyanin is blue pigment redox active, secondary metabolites produced by P. aeruginosa. The current study deals with biosynthesis, purification and bioactivity of pyocyanin produced by P. aeruginosa.
Design: Pyocyanin extraction was done by chloroform method and concentration was determined by multiplying the optical density at 520 nm by 17.072 expressed as µg/ml. Biological activity of pyocyanin was determined by well diffusion procedure.
Results: According to the source of infection, results showed that P. aeruginosa were most common in ear infection (30%) followed by wounds (22%), burns (17%), urine (13%) and each in stool and diabetes (9%). In this study the high resistance of P. aeruginosa isolates to antibiotics were 19 (82.6 %) to piperacillin followed by 10(43.5%) to aztreonem, 8(34.8%) to meropenem, 6(26.1%) to amikacin, 5(21.7%) to ciprofloxacin then 2(8.7%) to cefotaxime. the urine isolate produced the largest amount of pyocyanin (15.894 µg/ml). pyaocyanin have antimicrobial activity against Pathogenic bacteria: Shigella, Staphyllococcus aureus and Staphyllococcus epidermedis. and pathogenic fungi and yeast: Aspergillus niger, Penicillium spp., Rhizopus spp, Trichophyton mentagrophyte, Rhodotorula spp., Alternaria alternate , Trichophyton rubrum and Candida spp
Conclusions: cefotaxime is the best antibiotic for P. aeruginosa. Antimicrobial activity of pyocyanin against gram positive more than gram negative bacteria but less than that observed against fungi (molds and yeast)